Health care advocates optimistic that pilot program will help close the ‘gap’

When House Speaker Beth Harwell revealed plans for Tennessee’s “3-Star Healthy Task Force” June 30, health care reform advocates welcomed news of a pilot program to extend TennCare benefits to honorably discharged veterans and those with substance abuse or mental health disorders.

If all goes according to plan, it would be approved by the federal Centers for Medicare and Medicaid Services, and state legislators would vote on the program in early 2017; phase two, which would extend TennCare benefits to all qualifying Tennesseans with incomes up to 138 percent of the poverty level, could go into effect by 2018.

An estimated 280,000 Tennesseans have been caught for years in the “coverage gap” without insurance since Tennessee opted out of Medicaid expansion under the Affordable Care Act and has not passed an alternative expansion plan, leaving billions of federal dollars on the table and thousands of citizens without health care.

Those who fall in the “gap” don’t qualify for TennCare, the state’s Medicaid program; they don’t make enough money to qualify for subsidies through the Affordable Care Act; they are too young for Medicare; or they aren’t offered, or can’t afford, insurance through their job.

The pilot program is an alternative to Gov. Bill Haslam’s Insure Tennessee, which failed to garner enough support to pass during the last two legislative sessions.

Michele Johnson, executive director of the Tennessee Justice Center, a non-profit law firm that helps low-income families gain access to health care, is concerned that many of her clients will continue to suffer while the politics play out. “Some of these people are in very dire, urgent situations and they may not make it,” said Johnson, a parishioner at Christ the King Church.

There are still many misconceptions about health care access and how many people work but are still ineligible for health insurance or federal subsidies, she said.

“There is a widespread misunderstanding, that people assume if you’re sick and you deserve it, you’ll get the health care you need,” Johnson said.

Many low-wage, hourly, or part-time workers are unable to afford health insurance. If they face a serious illness or injury, there’s only so much pro-bono medical care to go around.

“The system really can’t work if more people don’t have comprehensive health coverage,” Johnson said.

The Tennessee Justice Center website is filled with stories of Tennesseans from all over the state who are caught in a vicious cycle: They can’t work because they’re not healthy; they can’t get well without insurance; they can’t afford insurance without work; they can’t work because they’re not healthy.

This summer, members of Johnson’s staff are meeting and talking with people caught in the “coverage gap,” and helping them share their stories with community members and elected officials. “We’re still educating, still trying to mobilize and engage,” she said.

“Watching people find their voice so they stand up for themselves has really been a blessing,” Johnson said.

Without Medicaid expansion in the state, rural hospitals, suffering from decreased federal reimbursements, face looming closures. According to Johnson, seven have closed in the last few years. That makes it difficult, and sometimes life-threatening, for residents to be so far from medical care, but also negatively affects the economy. When hospitals close, staff lose their jobs, and with it, their insurance. “This doesn’t have to happen,” Johnson said. “The money is available to bring to Tennessee and shore up our health care infrastructure.”

‘A right to health care’

While summer is a slow time for legislators and lobbyists alike, Tennessee Catholic Public Policy Commission Executive Director Jennifer Murphy said it’s still important to keep issues like health care out in front of legislators, especially those running for election this season. “Ask them where they stand on the issues and try to make it clear where you’re coming from,” she said.

The Tennessee Catholic Public Policy Commission, the official voice of the state’s three bishops on public policy matters “strongly supports providing all Tennesseans with access to adequate health care, and calls for reform of our health care system to provide services to the greatest number of people regardless of their ability to pay. Our approach to health care is shaped by a simple, fundamental principle: every person has the right to adequate healthcare.”

When a bill is introduced related to the Task Force pilot program, most likely in January 2017, Murphy said, it was “absolutely” something she would be watching closely. “We want something passed,” she said.